The treatment of pulmonary sarcoidosis

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Presentation transcript:

The treatment of pulmonary sarcoidosis Marc A. Judson Respiratory Medicine Volume 106, Issue 10, Pages 1351-1361 (October 2012) DOI: 10.1016/j.rmed.2012.01.013 Copyright © 2012 Terms and Conditions

Figure 1 The natural course of pulmonary sarcoidosis. Granulomatous inflammation may resolve with or without therapy. Relapse occurs when granulomatous inflammation redevelops. Fibrosis is suspected to be related to granulomatous inflammation, probably influenced by host factors. Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions

Figure 2 Factors involved in the decision to treat pulmonary sarcoidosis. Ideally, treatment should be based on evidence of granulomatous inflammation, significant physiologic impact resulting from the granulomatous inflammation, and significant functional impact from the physiologic impairment. Measurements in bold represent the most common measurements assessed. BAL, bronchoalveolar lavage; ACE, angiotensin converting enzyme; FVC, forced vital capacity; FEV1, forced expiratory volume in 1s; DLCO, diffusing capacity; 6MWT, 6-minute walk test (distance); HRQoL, health related quality of life questionnaires. Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions

Figure 3 The treatment approach to newly diagnosed disease. FVC: forced vital capacity. ∗Suggested by the author. Could substitute FVC criteria with another objective measure of physiologic impairment (e.g., forced expiratory volume in one second, diffusing capacity). Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions

Figure 4 The duration of therapy could determine the chance of relapse because sarcoidosis treatment may not affect the natural course of disease. If the duration of therapy exceeds the duration of disease activity (Therapy A), then the patient will not relapse when therapy is withdrawn. If the duration of therapy is shorter than the duration of disease activity (Therapy B), then the patient will relapse when therapy is withdrawn. Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions

Figure 5 The treatment approach for established disease. FVC, forced vital capacity. ∗Suggested by the author. Could substitute FVC criteria with another objective measure of physiologic impairment (e.g., forced expiratory volume in one second, diffusing capacity). Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions

Figure 6 Corticosteroid (6 phase) treatment for pulmonary sarcoidosis. See Table 3 for suggested doses and duration of therapy in each phase. Ref. 1, reproduced with permission. Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions

Figure 7 The treatment approach to relapse during or after a corticosteroid taper. Respiratory Medicine 2012 106, 1351-1361DOI: (10.1016/j.rmed.2012.01.013) Copyright © 2012 Terms and Conditions